Provider Demographics
NPI:1659457406
Name:GODINES, REYNALDO (MD)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:
Last Name:GODINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450307
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0007
Mailing Address - Country:US
Mailing Address - Phone:956-727-4111
Mailing Address - Fax:956-727-4318
Practice Address - Street 1:6801 MCPHERSON RD
Practice Address - Street 2:SUITE 339
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-727-4111
Practice Address - Fax:956-727-4318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4354207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034895501Medicaid
TX034895501Medicaid
TX00ML49Medicare PIN